We provide guidance on gynecology conditions and recommend treatments for women in all stages of life. Below is a list of common conditions we manage and treatments we perform.


Gynecology Conditions

Abnormal Bleeding
Normal menstrual cycles (periods) commonly occur every 21 to 35 days and usually last for 3 to 7 days. Sudden changes in your bleeding pattern can indicate problems. See your provider for bleeding between cycles, if you bleed more than 7 days or experience extremely heavy bleeding. Bleeding after menopause and frequent spotting after sex should always be evaluated. If you’re unsure if your bleeding is normal, call us to discuss your concerns.

Bladder Problems
Leaking urine is not normal at any age. Sudden urges to urinate or having to get up frequently from sleep in order to go to the bathroom is not something that just has to be “lived with.” Accidentally leaking urine with coughing, sneezing, laughing, or lifting is called stress urinary incontinence. This can often be improved with exercise and other lifestyle changes. Sometimes an outpatient surgical procedure may be necessary. We can help assess the severity of your condition and suggest a treatment appropriate for you.

Endometriosis 
Endometriosis is a very common gynecologic problem. This condition can often cause pelvic pain for a week or two prior to the onset of your actual period. Endometriosis can also lead to chronic pelvic pain, pain with intercourse, or affect your ability to become pregnant. Surgical and non-surgical treatments are available. We can help assess the severity of your condition and suggest a treatment appropriate for you.

Hormone Imbalance
Fatigue, Premenstrual Syndrome (PMS), irregular bleeding, hot flashes, and night sweats can all be an indication of hormone imbalance. If you’re experiencing hormonal imbalance, we will work with you to determine a personalized treatment plan.

Menopause
This is a natural stage in women’s lives when they stop ovulating (releasing eggs), and ovarian function, production of estrogen and other hormones, reduces significantly. Menopause typically occurs in women age 35 through 60. It may be accompanied by unpleasant symptoms that can often be treated. We can help assess the severity of your condition and suggest a treatment appropriate for you.

Pelvic Pain
Intense period cramps, new pains in your lower abdomen, pain with sex, or pain with urination can be signs of potential problems. If you’re experiencing pelvic pain, we recommend a physical pelvic exam and sometimes an ultrasound to give us more detailed information of what may be the source of your pain. Once we have determined the potential cause of your pelvic pain, we can offer options to manage or alleviate the pain.

PMS
PMS refers to any of the unpleasant symptoms that some women experience during the 5 to 14 days prior to starting their periods. PMS symptoms often include irritability, bloating, cramps, emotional stress, and headache. There are ways we can manage your symptoms to help your periods be more comfortable.

Sexually Transmitted Diseases (STDs)
If you or your partner have had a different sexual partner since your last visit it may be appropriate to be tested for STDs. Many of these diseases can spread with no obvious symptoms, and condoms don’t prevent herpes or human papilloma virus (HPV), which are two of the most common STDs. If you’re concerned you may have a STD or potentially been exposed, or if you have vaginal discharge, blisters or bumps, then please let us know. We can offer advice on how to best avoid exposure to sexually transmitted diseases as well as treat infections.


Gynecology Exams and Treatments

In-Office Procedures

Pelvic Exam
We recommend you receive an annual pelvic exam as soon as you become sexually active, regardless of age. This important exam allows us to monitor the female organs for changes in size or shape and signs of disease like inflammation, masses, or fibroids. If any changes are discovered during your exam, we will recommend additional testing, such as a pelvic ultrasound for further examination.

Pap Smear
During your pelvic exam, we can perform a pap smear to test the cells in the cervix for any changes that could lead to cancer. The American College of Obstetricians and Gynecologists (ACOG) recommends:

  • Every woman should get her first pap smear test at 21 years old and continue to do so every three years until she turns 30.
  • Women aged 30-65 years old: every five years

An abnormal pap smear doesn’t always mean cancer. Many women experience cervical cell changes, and often those changes go back to normal on their own. Should you receive an abnormal pap smear, we will request additional testing like a colposcopy or cervical biopsy for closer examination of the changes. If biopsy is necessary, it’s usually very small and only minimally uncomfortable. You’ll be able to drive yourself home without any impairment after the procedure. Many low grade changes of the cervix will spontaneously regress and do not need treatment. If results of follow-up tests indicate significant changes, the abnormal cells will be removed. We offer the full range of treatment options so we can tailor the treatment to your specific situation. You will need follow-up testing after treatment and regular cervical cancer screening after the follow up is complete.

Clinical Breast Exam
It’s important to conduct monthly self breast exams to know what is normal for your breasts so you can notice small changes and report them right away.

ACOG advises women get a clinical breast exam:

  • Every one to three years for women 20-30 years old
  • Every year for women aged 40 and older

You should talk with us about your risk factors to make a decision about whether to have a clinical breast exam.

Endometrial Ablation
If you’re certain that you do not wish to become pregnant again and if your periods are heavy and negatively affecting your daily life then you may want to consider an outpatient surgical option. Uterine (Endometrial) Ablation is a minor procedure designed to destroy the majority of the lining tissue inside of the Uterus. Typically the procedure itself takes about fifteen minutes to perform and gives approximately a 90% probability of reducing your bleeding significantly. You are quickly back to normal activity with no long recovery time.  Some lucky patients never have menstrual bleeding again! We offer both in-office as well as outpatient surgical choices. Call today if your periods are controlling your life.  Most insurances require that other hormonal treatments be tried first. The method that we use is called ThermaChoice.  Further information may be found at http://www.pelvichealthsolutions.com/thermachoice

Essure
This is a revolutionary and minimally invasive means of permanent surgical sterilization.  This is done in the office under local anesthesia by means of a hysteroscope.  A hysteroscope is a very thin camera device used to look into the uterus and with the Essure procedure it is used to view the openings of the tubes.  An inert coil is placed under direct visualization into the opening of each tube.  It is very important that you plan on continuing some other form of reversible birth control for at least three months.  Three months after the procedure is complete it is very important to have an X ray test called a hysterosalpingogram (HSG) to confirm that both tubes are now completely blocked before relying on the procedure alone for birth control.    www.essure.com

Colposcopy / LEEP
The PAP smear is a screening tool used to detect potentially abnormal cells on the cervix. If there is evidence of abnormalities then we can utilize a microscope (Colposcope) to evaluate the cervix in more detail. If we determine that there are significant pre-Cancerous cells on the Cervix then one option for treatment is a LEEP procedure. LEEP stand for Loop Electrocautery Excision Procedure. After numbing the Cervix with a local anesthetic we shave off the area of abnormal cells using a wire loop.  Using over the counter Ibuprofen or Naproxen may help minimize any cramping.  You will be able to drive yourself home from the office.

Minimally Invasive Surgery

Laparoscopic Hysterectomy

Certain gynecologic problems may ultimately require hysterectomy (or removal of the uterus). This can be accomplished several different ways. The old fashion abdominal incision is sometimes necessary. A hysterectomy can also be performed vaginally. There are many instances when removal of the uterus may be accomplished through the laparoscope and the patient may be able to go home the same day. If the hysterectomy is performed laparoscopically the patient can also often returned to normal activities within 2 weeks. Laparoscopic hysterectomy would require 3 small incisions in the abdomen each approximately 1/2 inch long.

Urethral Slings

Stress urinary incontinence or accidental leakage of urine with coughing, laughing, or lifting is a very common problem. Sometimes lifestyle changes such as pelvic floor exercises can make a big difference. If surgery is necessary the TVT Abbrevo suburethral sling is a very effective means of surgically correcting this incontinence problem. This involves a very small piece of nonabsorbable material placed through a vaginal incision less than 1 inch long. Typically the patient is able to go home same day and return to normal activities within just a few weeks. This has a very high success rate and patient’s experience very little discomfort with the procedure.

Sterilization

For those patients who have completed their family in desire in the desire permanent birth control, there are a few options. Laparoscopic tubal ligation is a very safe affective option that is been around for a long time. Patients typically go home just a few hours after the procedure and may return to normal activities within one to 2 days.

The Essure procedure is a very effective means of permanent birth control that can be done in the office with no incisions or any down time. This is done under local anesthesia in the office through an instrument called a hysteroscope.  Continuing your current form of birth control for 3-6 months till an X-Ray test confirms the tubes are blocked is extremely important to prevent an unanticipated pregnancy.

Uterine Ablation

Uterine or endometrial ablation is an outpatient procedure that treats the lining of the uterus in such a way that the periods are much lighter or, for some patients, actually stop altogether. It is important that the patient is certain that she has completed her family before proceeding with this.  This procedure is not intended as a sterilization procedure so it would be important that she have a sterilization procedure of some type.  The sterilization may be done at the same time as the ablation.  The endometrial ablation can be done in the office under certain circumstances but can also be done under anesthesia in the operating room. Either way, this is an outpatient procedure and the patient is able to return to normal activities very quickly.

Urogynecology & Pelvic Support

Uterine Prolapse

This is the dropping of the uterus into the vaginal canal. Quite commonly this problem can occur after childbirth and can cause pressure, pain, or bulging from the vagina. Although surgery is typically needed to correct this problem the newer options can be performed on an outpatient basis with a quick return to most activities.

Bladder/Vaginal Prolapse

Similar to uterine prolapse, the bladder and the vagina itself can drop after childbirth or injury. The symptoms are similar. Sometimes these prolapse problems do not cause any significant symptoms and may not need to be treated.  There is a nonsurgical option called a pessary. This is a device that can be placed, removed, and replaced into to vagina to basically prop things back where they belong.  There are also surgical options available.

Cystocele and Rectocele Repair

Cystocele refers to the specific bulge below the bladder that may occur after childbirth. It is often associated with Stress Urinary Incontinence but can cause other problems as well. Rectocele refers to a bulging into the vagina from the rectal wall. Constipation, pressure, and splinting (the need to apply pressure in the vagina to allow for bowel movements) are common symptoms. Kaegel exercises (pelvic floor muscle exercises), physical therapy, pessaries, and outpatient surgeries are common corrective measures discussed for the problems.